DYSLEXIA

Dr Ben Hayes
11:00-11:50
24th March 2023
G03 Bedford Way

Psychology and Education

Dyslexia. A troubled concept. The charges:

Dyslexia:
1) has no clear definition, and cannot be differentiated from other
reading difficulties;
2) is a product of over-anxious parents, seeking to explain and
justify their children’s learning difficulties;
3) is a ‘middle-class’ myth, more common in pupils from wealthier
backgrounds for social rather than scientific reasons;
4) is over-diagnosed, especially by educational psychologists
unfamiliar with the term and/or seeking to appease over-anxious
parents; and
5) is frequently associated with high intelligence, despite there
being no scientific basis for this claim.

•Kirby (2020)
Overview
• What is dyslexia?
• Issues in Identification & Assessment
• Theories about Causes of Dyslexia
• Can Teaching Methods Cause Dyslexia?
• Can Teaching Methods Cure Dyslexia?
• Brain function: Dyslexia & Instruction
• Can modern technology help?
• Conclusions
 What is Dyslexia?
(Critchley & Critchley 1978)

• ‘A disorder manifested by difficulty in

learning to read despite conventional
instruction, adequate intelligence and
sociocultural opportunity.’
• ‘It depends on fundamental cognitive
disabilities which are frequently of
constitutional origin.’
 What is Dyslexia?
(McGuinness,1997 p.122)

• ‘a label applied to children who are so

confused by their poor reading instruction
that they can’t overcome it without
special help’

• ‘nor do so-called dyslexic children have

any more trouble learning to read than
other children if they are taught with an
appropriate method.’
 What is Dyslexia?
(British Psychological Society, 1999 p18)

• ‘Dyslexia is evident when accurate and

fluent word reading and/or spelling is
learnt very incompletely or with great
difficulty.’
• ‘This focuses on literacy learning at the
‘word level’ and implies that the problem
is severe and persistent despite
appropriate learning opportunities.’
 What is Dyslexia?
(Jim Rose, 2009)
Identifying and Teaching Children and Young People with Dyslexia and Literacy Difficulties
An independent report from Sir Jim Rose to the Secretary of State for Children, Schools and Families. June 2009.

• Dyslexia is a learning difficulty that primarily affects the skills involved in

accurate and fluent word reading and spelling.

• Characteristic features of dyslexia are difficulties in phonological awareness, verbal

memory and verbal processing speed.

• Dyslexia occurs across the range of intellectual abilities.

• It is best thought of as a continuum, not a distinct category, and there are no clear
cut-off points.

• Co-occurring difficulties may be seen in aspects of language, motor co-ordination,

mental calculation, concentration and personal organisation, but these are not, by
themselves, markers of dyslexia.

• A good indication of the severity and persistence of dyslexic difficulties can be

gained by examining how the individual responds or has responded to well founded
intervention.
Identification and assessment: Evidence
against the ‘IQ-achievement’ discrepancy
approach
• Children with low IQs can have good word reading
skills (Siegel, 1992).

• A meta analysis of 46 studies found large overlaps

between poor readers with and without an IQ-
achievement discrepancy and negligible to small
differences found on variables closely related to the
reading process. (Stuebing, et al., 2002)

• Poor readers with and without a discrepancy do not

differ in their response to intervention (Stage, et al.,
2003).
Identification and assessment: the impact
of a diagnosis.
• Qualitative studies show a range of responses to
diagnosis, with some findings indicating that it can be
a positive process (Leitao et al. 2017), and some
identifying negative outcomes (e.g. Lithari, 2018).
• Cathryn Knight (2021) used the millennial cohort study
to look at 721 children who were diagnosed with
dyslexia and a matched set of children (the same
reading levels, sociodemographic factors, gender,
income, education level and country for example).
• She found that simply having the label gave children
lower beliefs about their ability and reduced life
aspirations for the children, their parents and their
teachers.
 What Causes Dyslexia?
• Early researchers focused on visual processing problems:
‘congenital word blindness’ (Hinshelwood, 1900) or
‘strephosymbolia’ (twisted symbols) (Orton, 1925) linked
to delayed establishment of hemispheric dominance
(failure to suppress mirror image alternatives producing
confusions of ‘b’ &‘d’, ‘saw’ & ‘was’)

• In 1970-80s careful experimental work showed verbal

mediation was implicated in the apparent visual
difficulties - substituting a written for a verbal response
could eliminate differences between normally developing
readers and those with dyslexia (Vellutino, 1987).
Dyslexia as a Subtle Language Difficulty
• Many key reading skills are language related.
Children who find reading difficult have
difficulties with phonemic segmentation and
phonological coding.

• Children with dyslexia form mental

representations of the sounds of language that
are poorly specified or ‘fuzzy’. This makes it
difficult to develop an awareness of the internal
sound structure of words and to learn letter-
sound relationships (Snowling, 2000).
• “The science of dyslexia is well advanced and
theory can be used to guide the design of
intervention approaches. Convergent evidence
now presents a strong rationale for considering
dyslexia as the behavioural outcome of a number
of different developmental pathways, mediated
by a phonological deficit.”

 Snowling 2011.
Carroll, Solity and Shapiro (2015).

“In conclusion, we confirmed that

the best predictors of dyslexia at
school entry were PK, PA, VSTM and
RN. However, there was
considerable individual variability
among poor readers, with many
different deficits linking to the
disorder and most poor readers
showing more than one deficit.”

“Results indicate that the causes of

poor reading are multiple,
interacting and probabilistic, rather
than deterministic.”
What role might genes have in causing Dyslexia?

• Despite the complexity of language and learning disorders,

individual genes are being defined which appear to influence the
development of abilities that are necessary in speech, language,
and reading.

• Most of these candidate genes have been associated with

several learning and language phenotypes, suggesting that they
facilitate learning processes which are basic to learning reading
and language.

• However, despite replicated evidence very few coding mutations

have been reported to account for their influence on these
disorders.
Smith (2011)
• This has led to the hypothesis that mutations
affecting reading and related disorders are
likely to be in regulatory regions.

• Alterations of gene expression can be caused

by mutations in gene promoters and
enhancers located near the gene. Mutations
in genes that mediate epigenetic controls of
gene expression have been found that affect
developmental learning disorders.
John Kershner. 2019.
https://doi.org/10.1016/j.tine.2018.12.001

• A comprehensive review of gene/environment

factors that might affect reading.

• Epigenetics suggests the importance of

identifying circumstances that influence reading-
related maturational timing.
• Dyslexia may be an unexceptional genetic
variation resulting from gene/environment
interactions”
Can teaching methods cause dyslexia?

• ‘Whole language’ approach, popularised by Goodman (1967) and

Smith (1978) implicated in reading standards.

• Reading was conceived of as a ‘psycholinguistic guessing game’

where features of a printed word were not thought to be
processed in detail but used to test hypotheses generated from
grammatical context and the meaning of the passage.

• Problems:
 Even skilled adult readers are only able to predict 25% of the
words in connected prose and prediction took longer than just
looking at the word (Gough, et al., 1981).
 Reading for meaning proved to be dependent on good word
decoding skills, rather than the other way round (see Adams &
Bruck, 1993).
Importance of Phonics in Teaching Reading

• Reviews and meta-analyses of effectiveness

of different methods for teaching reading
have highlighted a need for explicit and
systematic teaching of letter-sound
correspondences in reading alongside a
focus on reading for meaning (Snow & Juel,
2005).

• The debate moved on to different

approaches to phonics teaching.
 Hatcher, Hulme and Snowling (2004)
Study Design
• Four matched groups of reception-year children (aged 4-5 years)
were randomly assigned to experimental teaching conditions
(delivered in groups of 10 to 15 for three 10-minute sessions per
week):

 Reading with Rhyme,

 Reading with Phoneme,
 Reading with Rhyme and Phoneme,
 Reading - control condition where children were taught as a
class, in groups and as individuals).

• In each condition there was a strong phonic component and the

same amount of time spent on reading instruction.
Hatcher, Hulme and Snowling (2004)
Results

• For normally developing children no differential effects of the

different teaching programmes were found.

• For children identified as at risk of reading failure, training in

phoneme skills resulted in greater gains in phoneme awareness
and in reading skills.

• These results suggest that any reading programme with a highly

structured phonic component is sufficient for most 4-5-year-old
children to learn to read effectively but for those at risk,
additional training in phoneme awareness and linking phonemes
with letters is required.
The Reading Framework (2021)

Synthetic phonics

Phonics is a body of knowledge that is necessary for children to learn

to read and spell. Because of the complex alphabetic code of English,
children are taught explicitly the correspondences between letters
and sounds (graphemes and phonemes), as well as the skill of
blending the individual sounds together to read. The term ‘synthetic’
phonics refers to the verb ‘synthesise’, meaning ‘to combine’.

The skill of segmenting words into their individual sounds is needed

for spelling. Word reading and spelling are ‘reversible processes’.
Reading involves blending sounds to say a whole word; spelling
involves segmenting a whole word to identify the sounds in it. There
is convincing evidence of the value of systematic synthetic phonics
(SSP).
Key components of a synthetic approach
(Rose 2006)
Can teaching methods cure dyslexia?
 Torgesen et al. (2001) Intervention Study

• Two interventions were implemented with 9-10-year old children

who had been receiving special education services for dyslexia for at
least 16 months and whose reading attainments were at a 5-6 year
age equivalent level.

• The children were randomly allocated to Auditory Discrimination in

Depth and Embedded Phonics. Both provided supportive and explicit
teaching on phonemic awareness and phonemic-based decoding
strategies.

• The interventions were both intensive, providing 67.5 hours of

individual teaching in two 50 minute sessions each day for around 8
weeks.
 Torgesen et al. (2001): Results
Standard score 95

90

85

ADD
80
EP

75

Pre-pretest Pretest Posttest 1yr 2yr

Points at which reading was assessed

Caveat 1: that these are group averages, the interventions were not
equally successful with all children.
Caveat 2: despite improvements in reading accuracy, reading
fluency remained substantially below average, a common finding
from intervention programmes for children with dyslexia
• Shanahan (2021) provides a review of effective teaching for
those considered to have dyslexia which considers the findings
of 32 meta-analyses on the topic.

• “In all cases, those things proven advantageous to teach to

students with dyslexia have been found beneficial for normally
achieving students as well. There are still questions as to the
most efficacious amounts and timings of such teaching,
however. The most certain results were for phonemic
awareness, phonics, reading comprehension strategies, and
text structure instruction.” (p14).
Left hemisphere brain regions engaged during reading
and reading-related tasks. (Goswami, 2006)
Reading interventions: Effects on the brain.

• A 28 hour instructional treatment delivered

in 2 hour sessions over 14 days that focused
on linguistic awareness, the alphabetic
principle, fluency and reading
comprehension. (Aylward et al., 2003.)

• 10 Dyslexic children improved significantly

from the beginning to the end of the
intervention on three measures of reading.

• fMRI information gathered.

 Right and left superior parietal
region during phoneme mapping:

(A) Areas of greater activation

for controls than children with
dyslexia at the initial scan.

(B) Areas of greater activation

for controls than children with
dyslexia at the follow-up scan.

• “Results of this study demonstrate that after 3 weeks of

comprehensive treatment, brain activation patterns in children with
dyslexia changed to resemble the patterns of normal control subjects.”
(Aylward et al., 2003.)
• “Children with genetically constrained
developmental dyslexia are not only
teachable, as evidenced by improvement in
scores on reading tests, but that fairly brief,
intensive intervention can be associated with
observable changes in the brain’s response”
p218. (Aylward et al., 2003.)
Imaging studies: An overview.

• Analysis of the results from 8 brain imaging

studies (2002-2008).

• “All fMRI investigations of reading

interventions show evidence of normalisation
of brain activation in poor readers who
complete a reading intervention”

• Molfese, P. in Breznitz et. al. (2012)

 Reading Interventions: Effects on the Brain 2.
• Following an intensive, phonologically-based intervention reading accuracy
scores of eight 7-17 year olds with severe dyslexia rose into the average range
and there was a significant increase in left hemisphere activation of areas
typically activated in normally developing readers. (Simos et al.,2002)

• Simos et al. (2007) provided an intensive intervention to 15 pupils with

dyslexia, aged 6-8 years, previously been identified as inadequate responders
to reading instruction effective for most children. It focused on phonological
decoding skills for 8 weeks (2x50 mins/day) and on rapid word recognition
ability for a further 8 weeks (1 hr/day).
 Statistically and educationally significant improvements in reading test scores were
noted for 8 of the children who also showed “normalizing” changes in brain
activity.
 The other 7 children did not show an adequate response to intervention or
normalizing changes in brain functioning.
 Normally developing paired readers did not show systematic changes in brain
activity (enabling the effects of developmental changes or normal classroom
teaching to be ruled out).
• “There is good evidence to show that
phonological-based interventions are
effective in ameliorating dyslexic
difficulties.”

• Duff and Clarke (2011)

Does technology offer any benefits?

“This includes smartphones, mp3 players such as the

iPod, and tablet computers. Youth and adults alike have
adopted mobile technologies not only for leisure
activities such as listening to music and playing games
but also for keeping organised and for assisting with
learning.”

“Although applications for mobile technologies can assist

students with dyslexia with general self-confidence and
specific skills such as reading, writing, spelling and
organisation, they do not replace the traditional
teaching and learning strategies that have a strong
evidence base to support them.”
Reid, Strnadova & Cummings (2013)
New and novel interventions?

• Costanzo et al, (2019)

• Transcranial direct current stimulation. (tDCS)

• Noninvasive brain stimulation transiently

modulates reading ability in individuals with
dyslexia by facilitating the underactive neural
pathways. Long term effects were explored in
this study with some positive effects.
• Early stages of exploration.
• Replication needed.
Technology supporting implementation and
fidelity.
• Hayes, Heather, Jones and Clarke (2018)

• 20-25% - Typical intervention rates for Precision

Teaching (an evidence based intervention that can be
used for literacy skills).

• When implemented on a website that completes some

tasks for the adult automatically implementation rates
can improve to 70%.

• The webiste records what has been done and helps the
school see if it is being done well and making an
impact.
The orthography of the language of instruction
• Writing systems that do not use small speech sounds as the basis for
written symbols should present fewer difficulties for individuals with
phonological problems.

 Wydell and Butterworth (1999) present a case study of a dyslexic boy,

bilingual in English and Japanese, who only showed reading and
writing difficulties in English.

• Alphabetic languages vary in the transparency of their orthographies (the

consistency with which the written symbols map onto sounds). English is
notoriously inconsistent.

 Caravolas (2005) reviewed studies showing that children with dyslexia

typically experience milder difficulties, in particular with reading
accuracy relative to reading fluency and spelling, in more transparent
orthographies.
 Dyslexia: Some Conclusions
• Vellutino et al. (2004) describe dyslexia as a ‘complex
condition that depends on the dynamic interaction
between certain innate susceptibilities as well as the
home and school environments on the one hand, and
the cultures in which children learn to read on the
other.’ (p18).

• It is possible to argue both that inadequate instruction

or other experiential factors are responsible for the
problems of many poor readers and that biological
factors are important. This reflects developing
understanding of the ways in which brain and
environment interact in the process of learning to read.
Finally – psychologists working with children,
parents and teachers:

Limitations of a “medical model”.

• Critiques of a ‘medical model’ (e.g. Gameson et al.,
2005, Todd, 2007) have highlighted that it;

 Often implies within-person solutions are needed

 Can ‘pathologise’ children
 Tends to disempower teachers and parents and
imply the need for ‘specialists’ (Ross 2017)
 Is seen as being based on a linear model of cause
and effect
 Implies that change is less likely or impossible.
Finally – psychologists working with children,
parents and teachers: Some critique by asking
what does using the word ‘dyslexia’ add?
There is no evidence that children with a diagnosis need a different or
specific intervention to other struggling readers.

There is no test or check that can determine whether a child is dyslexic. It is

a matter of severity and persistence of difficulties over time. The same
difficulties that all struggling readers have.
– Elliott & Grigorenko (2014)
– Gibbs & Elliott (2020)

Identifying someone as ‘dyslexic’ actively reduces their self-belief and

aspirations compared to matched controls.
– Knight (2021)

The danger of self-fulfilling prophecies in education.

– Chandrasegaran & Padmakumari (2018).
Overview
• What is dyslexia?
• Issues in Identification & Assessment
• Theories about Causes of Dyslexia
• Can Teaching Methods Cause Dyslexia?
• Can Teaching Methods Cure Dyslexia?
• Brain function: Dyslexia & Instruction
• Can modern technology help?
• Conclusions